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題 名 | Evaluating the Validity of Serum Neopterin in the Diagnosis of Pulmonary Tuberculosis Infection with Different Severities=評估以血清Neopterin在不同嚴重度肺結核患者之診斷效度 |
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作 者 | 趙文震; 吳盈勳; 黃瑞明; 簡順添; | 書刊名 | 胸腔醫學 |
卷 期 | 27:6 2012.12[民101.12] |
頁 次 | 頁327-337 |
分類號 | 415.462 |
關鍵詞 | 結核; 生物標誌; 嚴重度; Neopterin; Tuberculosis; Biomarker; Severity; |
語 文 | 英文(English) |
中文摘要 | 背景:Neopterin是巨噬細胞所分泌之生物標誌,研究已證實在結核感染會上升但因整體診斷效度不佳鮮少有研究討論其在不同臨床狀況時的應用,本研究旨在探討血清中Neopterin在不同嚴重度肺結核患者之診斷效度。方法:我們前瞻性收案2010年1月至2010年12月間因痰液培養確診結核而入住胸腔病院之肺結核患者,我們收集患者血液並分析血清中Neopterin及相關細胞激素和臨床狀況之間的相關性。結果:我們共收集78位不同嚴重度肺結核患者及20位健康對照組血清並檢測其生物標誌,我們以痰液抗酸染色價數區分患者嚴重度,42位(54%)一價以上定義為嚴重結核;36位(46%)抹片陰性或是一價的患者定義為輕度結核。我們發現相對於健康人,血清中巨噬細胞相關之細胞激素如Neopterin(p<0.005)及Interferon-γ(p<0.05)在嚴重結核個案會明顯升高,相對地非巨噬細胞相關細胞激素如TNF-α、IL-6及局部作用的單核細胞趨化蛋白-1(MCP-1)則無明顯差異。另外輕度結核患者上述生物標誌之血清濃度皆無明顯上升這應該也是生物標誌應用一般肺結核時診斷效度不佳的原因。於變化並不能早期區分測抹片陽性患者培養陰轉與否。最後我們證實Neopterin 和IFN-γ之間的相關強度並不強(r=0.324, p=0.005)所以應有其獨立於IFN-γ的意義,最後我們分析上述五種生物標誌後發現Neopterin在嚴重結核個案有最好的診斷效度。結論:血清中Neopterin 濃度在嚴重肺結核個案具良好的診斷效度,在輕度肺結核個案其診斷效度不佳。 |
英文摘要 | Background: Neopterin, produced by macrophages in tuberculosis (TB) infection, is still rarely used in clinical practice because of the poor validity. No study has been conducted to evaluate its efficacy under different clinical conditions. In this study, we aimed to investigate the role of serum neopterin in pulmonary TB infection of different severities.Materials and Methods: We prospectively enrolled culture-proved pulmonary TB patients attending a TB referral hospital in southern Taiwan, and collected their serum for analysis.Results: In all, 78 TB patients and 20 healthy controls were enrolled; 42 (54%) patients had severe TB, defined as sputum acid-fast stain (AFS) above 1+ and 36 (46%) had mild TB with AFS below or equal to 1+. In the severe TB patients, serum neopterin (p<0.005) and interferon-γ (p<0.05) were higher than in the controls, but tumor necrosis-α, monocyte chemotactic protein-1, and interleukine-6 were similar to the controls. The 5 tested biomarker levels were similar between the mild TB cases and the controls, so the poor validity in this patient population was not surprising. We found that serum neopterin has better accuracy in diagnosing severe TB than the other biomarkers.Conclusion: Serum neopterin is an accurate diagnostic biomarker in severe pulmonary TB cases, but not in mild TB cases. |
本系統中英文摘要資訊取自各篇刊載內容。